Universal definition of loss to follow-up in HIV treatment programs: a statistical analysis of 111 facilities in Africa, Asia, and Latin America.Reportar como inadecuado

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* Corresponding author 1 CIDRZ - Centre for Infectious Disease Research in Zambia 2 UAB - The University of Alabama at Birmingham Birmingham 3 Indiana University 4 RTI International 5 The Kirby Institute 6 Fundación Huésped 7 Universität Bern Bern 8 Zambian Ministry of Health 9 Epidémiologie et Biostatistique Bordeaux 10 Instituto de Medicina Tropical Alexander von Humboldt 11 Chiang Mai University 12 Amo-Congo 13 University of California at San Francisco 14 University of Cape Town 15 National Institutes of Health

Abstract : BACKGROUND: Although patient attrition is recognized as a threat to the long-term success of antiretroviral therapy programs worldwide, there is no universal definition for classifying patients as lost to follow-up LTFU. We analyzed data from health facilities across Africa, Asia, and Latin America to empirically determine a standard LTFU definition. METHODS AND FINDINGS: At a set -status classification- date, patients were categorized as either -active- or -LTFU- according to different intervals from time of last clinic encounter. For each threshold, we looked forward 365 d to assess the performance and accuracy of this initial classification. The best-performing definition for LTFU had the lowest proportion of patients misclassified as active or LTFU. Observational data from 111 health facilities-representing 180,718 patients from 19 countries-were included in this study. In the primary analysis, for which data from all facilities were pooled, an interval of 180 d 95% confidence interval CI: 173-181 d since last patient encounter resulted in the fewest misclassifications 7.7%, 95% CI: 7.6%-7.8%. A secondary analysis that gave equal weight to cohorts and to regions generated a similar result 175 d; however, an alternate approach that used inverse weighting for cohorts based on variance and equal weighting for regions produced a slightly lower summary measure 150 d. When examined at the facility level, the best-performing definition varied from 58 to 383 d mean=150 d, but when a standard definition of 180 d was applied to each facility, only slight increases in misclassification mean=1.2%, 95% CI: 1.0%-1.5% were observed. Using this definition, the proportion of patients classified as LTFU by facility ranged from 3.1% to 45.1% mean=19.9%, 95% CI: 19.1%-21.7%. CONCLUSIONS: Based on this evaluation, we recommend the adoption of ≥180 d since the last clinic visit as a standard LTFU definition. Such standardization is an important step to understanding the reasons that underlie patient attrition and establishing more reliable and comparable program evaluation worldwide. Please see later in the article for the Editors- Summary.

Autor: Benjamin Chi - Constantin Yiannoutsos - Andrew Westfall - Jamie Newman - Jialun Zhou - Carina Cesar - Martin Brinkhof - Albert Mw

Fuente: https://hal.archives-ouvertes.fr/


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